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Cardio Module > 12. Anti Arrhythimic Drug Class 2-4 > Flashcards

12. Anti Arrhythimic Drug Class 2-4 Flashcards

1
Q

What are the effects of class II AADs?

A

Inhibit b-mediated increase in HR, contractile force and conduction velocity

  • decrease automaticity of SA node
  • decrease intracellular Ca overload
  • decrease conduction velocity of AV node, his/perkinje system, and ventricles
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2
Q

What are AAD class II primarily used for?

A

Protect ventricles from Supraventricular arrhythmias and junctional tachycardia

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3
Q

What are some adverse effects of ADD class II?

A
  • Reduce myocardial contractility
  • bradycardia
  • tachycardia and angina upon sudden withdrawal
  • bronchospasms
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4
Q

What are the contraindications of AAD class II?

A

Cardiogenic shock, 2nd and 3rd degree AV node block, sinus bradycardia, asthma

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5
Q

Can AAD class II be used to convert pts to NSR?

A

No, just a rate controlling medication, not used to convert pts to NSR

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6
Q

What is the use of type III AADs?

A

Prolong the refractory period by prolonging action potential, decreases the slop of phase 3 primarily

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7
Q

What are the effects of class III AADs?

A
  • Prolong duration of AP
  • Prolong refractory period
  • Block K channels
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8
Q

What AAD does amiodarone belong to?

A

Amiodarone is a class III AAD

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9
Q

What are amiodarone’s effects?

A
  • Block Na channels with fast T(recovery) - ectopic pacemakers
  • block Ca channels
  • noncompetative antagonist of alpha and beta AR receptors
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10
Q

What is amiodarone most commonly used for?

A

For atrial and ventricular arrhythmia conversion and maintenance of NSR

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11
Q

What are some problems w/ amiodarone?

A
  • Long half life, >50 days
  • CYP inhibitor: 3A4, 2D6, 2C9
  • Lots of monitoring! Done every 6 months
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12
Q

Class is dofetilide in?

A

AAD class III

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13
Q

What are the effects of dofetilide?

A
  • selective for I(kr) K channel
  • increase AP duration in atria and ventricles
  • no effect on conduction velocity or SA function
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14
Q

What is dofetilide used for? What is it an alternative to?

A

An alternative to amiodarone, used for atrial fibrillation and flutter conversion and maintenance of NSR

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15
Q

What are the contraindications of dofetilide?

A

QTc>440ms, CrCl

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16
Q

What kind of monitoring needs to be done on dofetilide?

A
  • electrolytes (Mg, K) - every 3-6 months
  • EKG, NSR continuous for 72 hrs - then every 3 months
  • renal function - every 3 months
17
Q

What class dose sotalol belong to?

A

AAD class III

18
Q

What are the effects of sotalol?

A
  • Nonselective b-AR antagonist
  • Decrease conduction velocity in AV node
  • Decrease automaticity of AV node
  • Prolong AV node refractory period
19
Q

What is the safest antiarrhythmic in pregnancy?

20
Q

What are the contraindications of sotalol?

A

CrCl450ms, bronchospasm, HR

21
Q

What is the black box warning for sotalol?

A

Initiate inpatient d/t QTc prolongation

22
Q

What should be monitored for sotalol?

A

HR, EKG, electrolytes, renal funciton

23
Q

What class does ibutilide belong to?

A

AAD class III

24
Q

What is ibutilide used for?

A

Conversion of atrial arrhythmias

25
What is the black box warning for ibutilide?
Pro-arrhythmic effect may cause QTc prolongation and TdP
26
What class does drondarone belong to?
AAD class III
27
What is drondarone indicated for?
Indicated to decrease hospitalizations for Afib in pts w/ NSR w/ a history of Afib
28
What pts should not be taking drondarone?
Heart Failure pts
29
What are the main contraindications of drondarone?
QTc>500ms, liver/lung toxicity w/ amiodarone
30
What drugs are included in AAD class IV? What is their indication?
Verapamil, diltiazem, bepridil. All are non-DHP CCBs
31
What are the effects of AAD class IV?
- Primarily in the SA/AV node - Decrease conduction velocity of AV node - Prolong refractory period in AV node - blocks Ca channels in vascular smooth muscle
32
What are the uses for AAD class IV?
- Reentry tachycardias involving AV node | - Reduce ventricular contractile rate during Afib/A flutter
33
What are some contraindications of AAD class IV?
- 2nd and 3rd degree heart block | - SBP
34
What is an important drug interaction of AAD class IV?
Use of CCB w/ BB enhances AV node block
35
What is magnesiums effect as an antiarrhythmic?
Treatment of digoxin-induced arrhythmias, treatment of TdP
36
What is the use of adenosine in arrhythmias?
- Increases K conductance --> hyperpolarization - GPCR mediated inhibition of Ca channels - Used for PSVT, particularly reentry
37
What is the use of digoxin in arrhythmias?
- for Afib, an adjunct to rate control, primarily for symptom treatment - Can be used safely in CHF pts
38
What drugs are part of class II?
Beta blockers, selective and non selective - Esmolol, metoprolol, atenolol - propranolol, timolol

Cardio Module (12 decks)

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